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Medicines which should not be regularly prescribed in primary care
Consultation
Information booklet
When we say primary care, we
mean the medical services that
people go to first.
These could be GP practices,
pharmacies, the dentist, and
eye clinics.
Although these proposals only
relate to things your GP (your
family doctor) does and not all
primary care services.
This consultation is about
how 9 medicines and medical
products are prescribed by GPs
in primary care.
2
About this document
The NHS is working on
spending its money better.
In 2017, the NHS spent just
over 9 billion pounds on
medicines on prescription in
the community.
Research shows that some
medicines can be replaced
with other medicines that
work better, are safer or cost
less money.
Clinical Commissioning
Groups, called CCGs, are NHS
organisations that plan and
organise medical services in a
local area.
NHS England has been
working with NHS Clinical
Commissioners, pharmacists
and other services to help the
NHS spend money better, and
to give patients better care.
3
What is the issue?
Together, they came up with
a list of 8 medicines and
medical products that should
not be prescribed regularly
in primary care.
They have also suggested
an update to how a type of
medicine called rubefacients
are prescribed in primary care.
We will explain what these
medicines are later in this
document.
About the suggested changes
This consultation is part of our
plan to look at how medicines
and medical products are
prescribed in the NHS and to
make this better.
4
What medicines do not work
very well or are not very safe
for patients to take;
What medicines work well,
but are more expensive when
compared to other medicines
that work as well;
To choose what medicines
we should focus on and
how they are prescribed,
we looked at:
What medicines work well,
but the NHS should not spend
money on them because they
do not treat serious illnesses.
5
Rubefacients are medicines
believed to help with pain in
a specific area of your body.
They are usually gels and
creams that you rub into the
skin where it hurts.
Rubefacients (apart from topical NSAIDs)
About this medicine
NSAID creams or gels can
reduce pain and swelling.
They do not have steroids in
them, which are a stronger
type of medicines.
Capsaicin is the thing in chilli
peppers that makes them hot.
It can be used in medicines
that help with pain.
Proposals for updated CCG guidance
6
We recommend that
rubefacients should not be
prescribed to new and existing
patients.
The current recommendations
are for rubefacients, not
NSAIDs creams or gels.
The recommendation
We also recommend that
capsaicin cream and NSAID
creams and gels should still be
prescribed to new and existing
patients when needed.
7
Every year the NHS spends just
under 5.5 million pounds on
prescriptions of rubefacients.
Why make this change?
Research shows that
rubefacients do not work very
well for pain in your muscles
or bones.
Research shows that
capsaicin cream works for
some types of pain.
8
Cardiology (the heart)
This medicine is usually
prescribed on its own or
together with other medicines
to lower high blood pressure.
We recommend that aliskiren
should not be prescribed to
new patients.
We also recommend that
patients who are prescribed
aliskiren will be supported to
start using different medicines
instead.
The recommendation
Aliskiren
About this medicine
Proposals for new CCG guidance
99
Why make this change?
This medicine works, but there
are less expensive medicines
that can replace aliskiren.
There is not enough evidence
from medical research to show
that aliskiren helps with high
blood pressure that does not
respond well to the usual
treatment.
Aliskiren works as well as
other medicines in treating
high blood pressure, but we
do not know how much it
helps patients live better and
longer lives.
1010
Amiodarone is a medicine
used to treat and prevent a
number of medical conditions
that give you irregular
heartbeats.
Amiodarone
About this medicine
We recommend that
amiodarone should not be
prescribed to new patients.
We also recommend that
amiodarone should be
prescribed only by a specialist
and in cases when other
treatment cannot be used or
didn’t work.
The recommendation
11
When this happens, a team of
medical specialists in different
areas needs to keep a close
eye on the patient.
It can be very toxic, that is
why patients who take it need
to be looked after closely by
different medical specialists
and with laboratory tests.
However some patients may
still need it. In these cases it
must be given to them by a
specialist.
Why make this change?
12
Dronedarone
About this medicine
Dronedarone is a medicine
used to keep the heartbeat
normal in patients who cannot
have other treatments or
medicines for this.
We recommend that
dronedarone should not be
prescribed for new patients.
We also recommend that
dronedarone should be
prescribed only by a specialist
and in very special cases,
for example when other
treatment cannot be used or
didn’t work.
The recommendation
13
When this happens, a team of
medical specialists in different
areas needs to keep a close
eye on the patient.
There are safer medicines than
dronedarone.
However some patients may
still need it. In these cases it
must be given to them by a
specialist.
Why make this change?
14
Dermatology (skin)Minocycline for acne
About this medicine
Minocycline is a type of
antibiotic that can be used
for many things, but is usually
used by primary care to treat
acne.
We recommend that
minocycline should not be
prescribed for new patients.
We also recommend that
patients who are prescribed
minocycline will be supported
to use different medicines.
The recommendation
15
Research shows that there
are some risks of using
minocycline, for example:
• Hepatitis, which is an illness
of your liver;
• Skin pigmentation, which
is when patches of skin on
your body change colour;
• Drug induced lupus, which
is when your body attacks
parts of itself, like your skin
or your joints.
Why make this change?
Research also shows that there
are better treatments that can
be used for acne.
16
Silk garments are special
clothes made out of medical
silk which are prescribed to
patients who have very bad
eczema or allergic reactions on
their skin.
We recommend that silk
garments should not be
prescribed to new patients.
Silk garments
About these products
The recommendation
We also recommend patients
should not be prescribed silk
garments anymore, and that
they are supported in this
change.
17
Prescribing these, because
they are not known to actually
work, is not a good way of the
NHS spending its money.
Research shows very little
evidence that silk garments
work in helping soothe the
symptoms for patients with
eczema.
Why make this change?
Last year, the NHS spent over
1 million pounds on these
products.
18
There are some products like
shower gels and soaps that
are prescribed to patients to
soothe itchy and very dry skin,
like when you have eczema.
Bath and shower preparations for dry or itchy skin
About these products
The recommendation
We recommend that such
gels and soaps should not be
prescribed to new patients.
We also recommend that
patients who get these gels
and soaps on prescription at
the moment will be supported
to start using leave-on lotions
instead.
19
Research shows that these
gels and soaps do not work
very well in the treatment of
eczema.
Why make this change?
We still want to encourage
patients to use leave-on
lotions to treat eczema, and
to use these instead of soap if
that helps them.
They also cost the NHS almost
16 million pounds in the last
year.
We will need to make sure
patients know how to use
these lotions.
20
Blood glucose testing strips for Type 2 Diabetes
About this product
Your body makes a substance
called insulin that makes sure
the glucose in your blood is at
a certain level, that it doesn’t
go up or down too much.
When you have type 2
diabetes your body doesn’t
make enough insulin, so the
level of glucose in your blood
goes too high.
Glucose is a type of sugar in
your blood.
Diabetes
2121
Patients with type 2 diabetes
may need to monitor their
glucose level. Some use a
special machine called a Blood
Glucose Tester.
This machine uses special strips
of plastic or paper.
You prick your finger with a
special needle to get a drop of
blood, put this on a strip and
put it in the machine.
The machine tests the blood
on the strip to check the level
of glucose in your blood.
We recommend that test
strips which cost more than
10 pounds for a pack of 50
are not prescribed for new
patients.
The recommendation
2222
We also recommend that
patients who are being
prescribed more expensive
strips will be supported to
start using test strips that cost
under 10 pounds for
a set of 50.
These changes will not
apply to patients who count
carbohydrates and are trained
on how to do this.
Carbohydrates are sugars and
starches found in foods like
bread and pasta.
2323
They can cost from around 5
pounds up to 17 pounds. Last
year, testing strips cost the
NHS just over 173 hundred
million pounds.
These recommendations
encourage CCGs and
prescribers to choose less
expensive items. They are not
about stopping prescribing.
Why make this change?
Recommending the use of
less expensive testing strips
that are as good as the more
expensive ones will save a lot
of money.
2424
Some people with Diabetes
need to take insulin, which is
a substance the body makes to
regulate blood sugar levels.
This is because your body
doesn’t make enough or any
insulin, or if the insulin your
body makes doesn’t work
properly.
Insulin pens are medical
devices that look like a pen
with a needle at the tip.
Needles for pre-filled and reusable insulin pens
About this product
Patients who need to take
insulin use these to inject
themselves.
2525
Needles for these pens have
different sizes, between 4 and
12 millimetres, and work with
different pens.
Some pens you can refill
with insulin while others are
already filled with the right
dose and you use just once.
They can cost between 4
pounds and 30 pounds for a
pack of 100 needles.
4 millimetre needles are the
safest to use for adults and
children in insulin pens.
2626
We recommend that insulin
pen needles costing over 5
pounds for a pack of 100
should not be prescribed to
new diabetes patients.
The recommendation
We also recommend that
patients who are prescribed
more expensive insulin pen
needles should be moved onto
needles costing less than 5
pounds for a set of 100, and
that they get the help they
need to make this change.
There are some needles that
work with most types of pens.
2727
Last year, the NHS spent just
over 33 million pounds on
needles for insulin pens.
Recommending the use of less
expensive needles that are as
good as the more expensive
ones will save a lot of money.
Why make this change?
These recommendations
encourage CCGs and
prescribers to choose less
expensive items. They are not
about stopping prescribing.
2828
The consultation
We are running a national
consultation to ask people
what they think about the
changes we are proposing.
You can have your say by filling
in our online survey from the
28th of November 2018 to the
28th of February 2019.
You may also like to attend
our face to face or online
events to discuss the
proposals.
You can complete the online
survey or book on these
events here:
https://tinyurl.com/y8z3kmlv
29
After the consultation
ends, we will look at all the
responses and write a report
that will be available online.
You can also contact us by
post at:
NHS England
PO Box 16738
Redditch
B97 9PT
You can also email us at
We also have an easy read
version of the survey here:
https://www.surveymonkey.
co.uk/r/9medicines
30
What we find out in the
consultation will be used to
write up the final version of
the guidance.
After we publish this final
guidance, we will expect CCGs
to keep it in mind when they
make decisions about how
they prescribe these medicines
and medical products.
Thank you.
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This booklet was created by CHANGE to support
a national consultation co-ordinated by
NHS England and NHS Clinical Commissioners
32
